_______________________________________________________

STEP 1 - Select your membership category based on your age

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STEP 2 - Select all categories where you participate:
(You must identify each category of participation to obtain insurance coverage for
that category. There is no additional charge for multiple categories)
___ PLAYER
___ COACH(Checkallthatapply)
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m +.''+''_+' ''.' m +.''+''_+' ''.'
*ForinformationonbecomingaCEPcertifiedcoachpleasevisit:
www.uslacrosse.org/cep.
___ OFFICIAL(Checkallthatapply)
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_______________ _______________
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All official category memberships expire 9/30, regardless of date joined.
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CharitableInformation: '+. .+.... + '+....''' _|' '+ ..))+.' '' _.++'' +| '+..+.. .+'+.+.!
! '+..+.. ... _______ YourtotalFee$_______
STEP 3 - Complete your payment information
PaymentInformation:
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m '..' '+.. '+.. 1.m'.. ________________________________
).+'+. '+'. _______ / ________
1+m +. '+.. ,| .||..' ''+. +'+.;. __________________
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________________________________________
STEP 4 - Please sign waiver to the right
ENROLLMENT FORM AND MEMBER AGREEMENT
InsuranceInformation
All categories except Fan include comprehensive secondary lacrosse insurance and
must sign below. Insurance information, including claim forms, can be found on our
website: www.uslacrosse.org.
SignatureRequiredforAcceptanceofMembership
In consideration of my membership in US Lacrosse, and my participation in US Lacrosse
sanctioned, recognized or sponsored events ("Covered Events"), I agree to the following:
1.WaiverandRelease:I am fully aware of and appreciate the risks, including the risks
of catastrophic injury, paralysis and even death, as well as other damages and losses,
associated with participation in a lacrosse event. I agree on behalf of myself, my heirs
and personal representatives, that US Lacrosse, the host organization and the sponsor
or sponsors with respect to a Covered Event, together with coaches, officials, volunteers,
employees, agents, officers and directors of the host organization and any such sponsors
shall not be held liable for any injury, loss of life or other loss or damage as a result of
my participation in a Covered Event. This Waiver & Release shall also be for the benefit
of and run in favor of any youth organization that requires participants to become
members of US Lacrosse as a condition to their participation in such organization's
youth lacrosse events, which shall constitute Covered Events for purposes of this Waiver
& Release, and any such youth lacrosse league shall constitute the host organization for
such Covered Events.
2.MedicalAttention: I hereby give my consent to US Lacrosse and the host organization of
any Covered Event to provide, through a medical staff of its choice, customary medi-
cal/athletic training attention, transportation and emergency services as warranted in the
course of my participation in Covered Events.
3. ReadinesstoCompete: I will only participate in those Covered Events in which I believe
I am physically and psychologically prepared to compete.
4. Information Certification: I certify that all information provided by me in this
application, including without limitation my membership category, is true, accurate
and complete and I understand that any untrue, inaccurate or incomplete statement
or information will automatically invalidate my membership and all of the benefits of
membership in US Lacrosse.
5.CodeofConduct: I agree to all terms on the reverse side of this form (refers to
accepted US Lacrosse/Positive Coaching Alliance Code of Conduct).
Participant Primary Medical Insurance Carrier is:

Policy Number:
If participant is under 18, then a parent or legal guardian of this participant must sign.
As member, or as parent or legal guardian of a member under 18, I hereby verify by my
signature below that I fully understand and accept each of the above conditions.
Signature:
Date:
PrintedNameofsignor:
Membership is annual and non-refundable
We suggest you renew online for the fastest and most efficient process:
www.uslacrosse.org.
MemberID#(if renewing and known)circleone:MaleFemale
Name:D.O.B:
Mailingaddress:
City:State:Zip:
Homephone:()Emailaddress:
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US Lacrosse National Headquarters 113 West University Parkway Baltimore, Maryland 21210-3300 ph: 410.235.6882 fax: 410.843.0390
WE708
100K/608
Code of Conduct
US LACROSSE AND THE POSITIVE
COACHING ALLIANCE
Lacrosse is the oldest American sport. Native Americans
played lacrosse centuries ago, long before our
colonies were settled. Through lacrosse, Native
Americans celebrated and emphasized their spiritual
and cultural values.
In an effort to promote appropriate values in the modern
game, US Lacrosse has partnered with the Positive
Coaching Alliance to promote positive coaching
and good sportsmanship for all levels of lacrosse. US
Lacrosse has included the following "Lacrosse Code
of Conduct" as part of its membership application
to encourage and foster appropriate values in play-
ers, coaches, parents, officials and spectators. US
Lacrosse believes that it should be a priority of every
lacrosse player, team, program and league to "Honor
the Game."
US LACROSSE CODE OF CONDUCT
Players, coaches, officials, parents and spectators are to
conduct themselves in a manner that "Honors the
Game" and demonstrates respect to other players,
coaches, officials, parents, spectators and fans. In
becoming a member of the lacrosse community an
individual assumes certain obligations and responsibili-
ties to the game of lacrosse and its participants. The
essential elements in this "Code of Conduct" are
HONESTY and INTEGRITY. Those who conduct
themselves in a manner that reflects these elements
will bring credit to the sport of lacrosse, themselves,
their team and their organization. It is only through
such conduct that our sport can continue to earn and
maintain a positive image and make its full contribution
to amateur sports in the United States and around the
world. US Lacrosse supports the following behaviors
for those who participate in the sport or are involved
in any way with US Lacrosse. The following essential
elements of the "Code of Conduct" must be followed:
Sportsmanship and teaching the concepts of fair play are essential to
the game and must be taught at all levels and developed both at
home and on the field during practices and games.
The value of good sportsmanship, the concepts of fair play, and the
skills of the game should always be placed above winning.
The safety and welfare of the players are of primary importance.
Coaches must always be aware of the tremendous influence they
have on their players. They are to strive to be positive role models
in dealing with young people, as well as adults.
Coaches should always demonstrate positive behaviors and reinforce
them to players, parents, officials and spectators alike. Players
should be specifically encouraged and positively reinforced by
coaches to demonstrate respect for teammates, opponents, officials
and spectators.
Players should always demonstrate positive behavior and respect
toward teammates, opponents, coaches, officials, parents and
spectators.
Coaches, players, parents and spectators are expected to demonstrate
the utmost respect for officials and reinforce that respect to players/
teammates. Coaches are also expected to educate their players as
to the important role of lacrosse officials and reinforce the ideal of
respect for the official to players/teammates.
Grievances or misunderstandings between coaches, officials or
any other parties involved with the sport should be communicated
through the proper channels and procedures, never on or about the
field of play in view of spectators or participants.
Officials are professionals and are therefore expected to conduct
themselves as such and in a manner that demonstrates total impartial-
ity, courtesy and fairness to all parties.
Spectators involved with the game must never permit anyone to
openly or maliciously criticize, badger, harass or threaten an official,
coach, player or opponent.
Coaches must be able to demonstrate a solid knowledge of the rules
of lacrosse, and should adhere to the rules in both the letter and the
spirit of the game.
Coaches should provide a basic knowledge of the rules to both play-
ers and spectators within his/her program. Attempts to manipulate
rules in an effort to take unfair advantage of an opponent, or to
teach deliberate unsportsmanlike conduct, is considered unacceptable
conduct.
Eligibility requirements, at all levels of the game, must be followed.
Rules and requirements such as age, previous level of participation,
team transfers, etc, have been established to encourage and maximize
participation, fair play and to promote safety.
To renew, choose one of the following:
Mail to: 113 West University Pkwy Baltimore, MD 21210-3300
Fax to: 410.843.0390
Log on to: www.uslacrosse.org
For more information call: 410.235.6882 x102
National Headquarters 113 West University Parkway Baltimore, Maryland 21210-3300
OR08